"Thus it is said that one who knows the enemy and knows himself will not be endangered in a hundred engagements."
Sun Tzu, The Art of War.

War on Terrorism

Monday, October 20, 2008

Bagram Hospital Staff Delivers Afghan Baby

By Air Force Staff Sgt. Rachel MartinezSpecial to American Forces Press Service

Oct. 20, 2008 - It was the middle of the night and pagers were going off inside Craig Joint Theater Hospital as staff scrambled to pull together the people and equipment needed for a successful procedure. The situation was not unusual except that this time it wasn't the life of a coalition servicemember they were trying to save. Instead, they were about to bring a new Afghan baby into the world.

Just after 5 a.m. Oct. 4, the hospital staff successfully delivered, by cesarean section, the first Afghan baby in the Craig Joint Theater Hospital.

The mother is a patient who was brought in five weeks ago after an explosion in her home. Despite major injuries to her upper and lower extremities, she was able to continue her pregnancy.

"We were primarily following this patient for her traumatic injuries, but the fact that she was also pregnant was always on our radar," said Air Force Capt. Ron Carr, an obstetrics nurse deployed from Travis Air Force Base, Calif.

The hospital's obstetrical team had recently started planning for how they might deliver the baby and manage the mother's significant injuries, Carr said.

"Because the standard of obstetrical care is different here than what we'd expect in the States," he continued, "we were not even sure how far along she actually was."

Before the hospital staff could acquire additional obstetrical equipment, the woman quietly went in to labor in the early hours of Oct. 4. During a normal delivery, the hospital staff would monitor contractions and measure the baby's heartbeat. But without the necessary equipment, the team had to make do with only Doppler ultrasound equipment capable of intermittently picking up the baby's heartbeat.

"We came together and made it work for us," Carr said. "We had to intermittently monitor the baby with our ultrasound and then feel for contractions with our hands. We had to use traditional medical techniques and teach the nurses how to put their hand on her belly to feel for the contraction so that we could then convey it to the doctor."

Over an hour and a half, the woman's contractions progressed from every 10 minutes to every three minutes.

"She was very close to having her baby," Carr said.

Due to the extent of the woman's injuries, the doctors decided a normal delivery would present too many complications, and decided to proceed with the more controlled environment of a cesarean section.

Though Craig Joint Theater Hospital is not equipped with an obstetrics department, many of the airmen deployed here have obstetric and neonatal experience. Airmen working as medical technicians in the emergency room and intermediate care ward were pulled to assist with the delivery. Obstetrics nurses and doctors, working in general medicine at the hospital, came together and prepared for the historic delivery.

"For the C-section, we had most of the equipment we needed, because it's a standard [operating room] procedure," Carr said. "We gathered together a C-section set out of instruments from other trauma sets we would use. We had a lot of the medications that we would use to stave off some of the more common OB complications, as well as the medications that we would routinely use post-partum. Some of it was luck, some of it was planning."

The biggest challenge was the lack of neonatal equipment. One key piece of equipment missing was a baby warmer.

"We needed something to keep the baby warm when she first arrived. We had about 15 minutes to come up with something to use in the emergency room," said Air Force Tech. Sgt. Jeremiah Diaz, a medical technician deployed from Nellis Air Force Base, Nev.

"First, we were thinking lights, then we ended up using a [warming blanket used for post-surgical patients]," Diaz said. "We made a little tent for the baby with coat hangers and an egg crate mattress."

A healthy Afghan baby girl was delivered that morning, and ever since, "her presence has been a ray of light," Carr said, noting the contrast between a new baby and the trauma the hospital staff sees daily.

"It's been very affirming of why we're here," he said. "We know we are here to help remedy the injuries of war, but for a lot of us, this made things kind of feel very normal, because this is what we do back home. It was very encouraging to see that the hospital could get together that rapidly to make it happen; everything went incredibly smooth."

Air Force Tech. Sgt. Roopa Schoop works in the emergency room as a medical technician. As a labor and delivery technician back at Nellis Air Force Base, Nev., she was interested in assisting with the delivery since hearing about the woman's pregnancy. Even though it was her day off, she helped in the delivery room and performed the initial assessment on the baby.

"I'd been thinking that it would be an amazing experience to help with the delivery," Schoop said. "I'm a mom, so I enjoy babies. I think it's good therapy to hold a baby. Most of us that were involved in the delivery have come back to hold her, because it is a good feeling."

The baby girl's mother did not name her for a few days, so the nurses in the intensive care unit started calling the baby Savannah. When the mother and grandfather heard the staff call her by that name, they would laugh. Three days after her birth, the mother decided to name the baby Zahra, which means "white flower" in Arabic. She has exceeded the doctor's expectations and acts as any healthy baby would.

"I wish the baby well," Schoop said. "We will leave, and hopefully she grows up a healthy and responsible girl."